Action Points

A statistical update from the AHA, CDC, and NIH notes that 68% of U.S. adults are overweight or obese, and 33% report engaging in no aerobic leisure-time physical activity.

The update also points out that data from the National Health and Nutrition Examination Survey indicate that between 1971 and 2004, average total energy consumption among U.S. adults increased by 22% in women and by 10% in men attributable primarily to greater average carbohydrate intake.

Although rates of heart disease and stroke continue to fall, a rising tide of unhealthy behaviors may start to reverse those improvements, according to an American Heart Association report.

Over 10 years, death due to cardiovascular disease fell by about 33%, and stroke mortality dropped 37%, Alan S. Go, MD, of Kaiser Permanente Northern California and chair of the writing committee for the annual report, and colleagues wrote online in Circulation: Journal of the American Heart Association.

But at the same time, more than two-thirds of adults are overweight or obese, and a third say they don't get any exercise, according to the AHA's "Heart Disease and Stroke Statistics -- 2013 Update," done in conjunction with the CDC and the NIH.

"We've made a lot of progress in improving outcomes for heart attack and stroke," Go told MedPage Today. "What's concerning to us is that trends in risk factors such as high blood pressure, obesity, and diabetes, are all going in the wrong direction."

Every year, the AHA, along with the CDC, NIH, and other government agencies, publish updated statistics on heart disease and stroke.

Donna Arnett, MD, of the University of Alabama at Birmingham and president of the AHA, said some troubling parts of this year's report are that about 20% of Americans still smoke, a proportion that has been flatlining for several years.

Also, increasing rates of obesity are leading to a higher prevalence of one of its main comorbidities, type 2 diabetes, which stood at 8% in this year's report.

"Those are really troubling figures when we think down the road about the future of cardiovascular disease in America," Arnett told MedPage Today.

Arnett said a key strategy to reversing those trends is to get the risk factors under control -- particularly when it comes to diet and exercise.

While 68% of adults are overweight or obese, more than a third (35%) are fully obese. For children, 32% are overweight or obese and 17% are fully obese.

Inactivity is high for both adults and children as well. A third of adults said they didn't get any leisure-time physical activity, while 18% of high-school girls and 10% of high-school boys didn't get 60 minutes a day of moderate activity over the course of a week.

Changing those behaviors is clearly a large challenge, Arnett said, but clinicians can also go after "lower-hanging fruit." Particularly, high blood pressure -- which accounts for 41% of cardiovascular disease mortality -- should be targeted, she said.

Currently, only 53% of adults with hypertension have their disease under control, according to the report.

The main challenge, Go said, is patient awareness of the importance of controlling blood pressure.

"Most people don't feel any symptoms of hypertension, so they don't understand the effects that their medications are having," he said. "We need patients to take a longer view, that their blood pressure does affect their risk of stroke or heart attack."

Health systems also need to be better about screening for hypertension, and clinicians need to expand their use of blood pressure medication combinations, he added.

"Rather than maximizing the dose of just one medication, most people need at least a couple of different medications to adequately control their disease," Go said.

Arnett added that high cholesterol would be another "low-hanging fruit" to target, as 14% of adults currently have uncontrolled high cholesterol, above 240 mg/dL.

Getting a handle on these risk factors will also help curb costs of cardiovascular care, which rose to $313 billion in 2009, up from $228 billion in 2008.

The rise is due to a "complicated array of factors," Arnett said, including the fact that the population is aging, as well as the improved survivorship from heart disease, which leads to an "increased complexity of the cardiovascular patient in terms of care at the end of life."

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